Drug Abuse Prevention

Research Findings from February, 2000 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate youth drug abuse prevention. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Preventing Adolescent Health Risk Behaviors

The purpose of this study was to examine 6-year follow-up data on adolescent health-risk from a nonrandomized controlled trial of an intervention combining teacher training, parent education, and social competency training. Two intervention conditions were studied. The full program provided intervention components in grades 1 through 6, the later intervention program was provided in only grades 5 and 6; students in the current follow-up sample were 18 years of age. Results indicate that compared to control group students, the full intervention group students reported significantly fewer violent acts, less heavy drinking, lower incidence of sexual intercourse, and fewer sexual partners. They also reported more commitment and attachment to school, better academic achievement, and less school misbehavior. The late intervention students did not differ significantly from the control group in health risk behaviors. Hawkins, J.D., Catalano, R.F., Kosterman, R., Abbott, R., and Hill, K.G. Preventing Adolescent Health-Risk Behaviors by Strengthening Protection during Childhood. Archives of Pediatric and Adolescent Medicine, 153, pp. 226-234, 1999.

ADHD and Early Drug Use

This study followed a community-based sample of low birth weight and normal birth weight children and their mothers, initially assessed at age 6 and followed up at age 11. Several findings are of note. Both low birth weight and normal birth weight subjects with ADHD (attention deficit hyperactivity disorder) were found to have increased risk of substance use by age 11. However, there was an interaction effect between ADHD and externalizing problems: children with low levels of externalizing problems were at low risk, and children with high levels of externalizing problems were at high risk for drug use, regardless of ADHD status. It was at moderate levels of externalizing problems that children with ADHD demonstrated increased risk for early drug use. Internalizing problems did not predict early drug use. The risk for drug use did not differ between those children who did or did not receive pharmacotherapy [usually methylphenidate (Ritalin)] as treatment for ADHD. Low parental monitoring and peer drug use were associated with increased risk for early drug use. Maternal history of depression, anxiety disorder, or substance abuse or dependence did not change the relationship between ADHD and children's drug use. Chilcoat, H.D. and Breslau, N. Pathways From ADHD to Early Drug Use. Journal of the American Academy of Child and Adolescent Psychiatry, 38, pp. 1347-1354, 1999.

Smoking Initiation and Escalation in Early Adolescent Minority Girls

The objective of this study was to examine the effectiveness of a drug abuse prevention program in reducing the initiation and escalation of smoking in a sample of predominantly minority 7th grade girls. The 15-session prevention intervention teaches social resistance skills within an intervention designed to promote personal and social competence skills. Smoking rates among girls from 29 New York City public schools who received the program (n=1,278) were compared with those of a control group of girls (n=931). Participants were less likely to initiate smoking compared to controls. There were also significant program effects on smoking intentions, smoking knowledge, perceived peer and adult smoking norms, drug refusal skills, and risk taking. Experimental smokers in the intervention group were less likely to escalate to monthly smoking relative to controls. Botvin, G.J., Griffin, K.W., Diaz, T., Miller, N. and Ifill-Williams, M. Smoking Initiation and Escalation in Early Adolescent Girls: One-Year Follow-Up of a School-Based Prevention Intervention for Minority Youth. Journal of the American Medical Women's Association, 54, pp. 1-6, 1999.

A Six-Year Follow-Up Study of Determinants of Heavy Cigarette Smoking Among High-School Seniors

Most adult cigarette smokers start smoking during adolescence. Few studies, however, have focused on adolescents that are heavy smokers. This study examined the link between risk and protective factors measured during early adolescence and heavy smoking when youth were high-school seniors. As part of a school-based survey, seventh grade students (N=743) reported on experimentation with psychoactive substances and psychosocial factors associated with smoking. By twelfth grade 12% of students (n=88) smoked a pack of cigarettes or more each day. Heavy smoking was predicted by: poor grades, experimentation with cigarettes or alcohol, a mother or many friends that smoke, and risk-taking behaviors in the seventh grade. Anti-smoking attitudes and those of one's parents and friends predicted rates of heavy smoking among girls in high school. Early intervention programs that address the social and psychological determinants of smoking may have important preventive effects in terms of experimental smoking and in later heavy smoking. Thus, prevention efforts that reduce, delay, or prevent early experimentation with smoking may significantly reduce heavy cigarette consumption in later adolescence and adulthood. Griffin, K.W., Botvin, G.J., Doyle, M.M., Diaz, T. and Epstein, J.A. A Six-Year Follow-Up Study of Determinants of Heavy Cigarette Smoking among High-School Seniors. Journal of Behavioral Medicine, 22, pp. 271-284, 1999.

10-Year Follow-Up of Project DARE

The present study examined the impact of Project DARE (Drug Abuse Resistance Education), a widespread drug-prevention program, 10 years after administration. A total of 1,002 6th grade students who had either received DARE or a standard drug-education curriculum, were reevaluated at age 20. Few differences were found between the 2 groups in terms of actual drug use, drug attitudes, or self-esteem, and in no case did the DARE group have a more successful outcome than the comparison group. Lynam, D.R., Milich, R., Zimmerman, R., Novak, S.P., Logan, T. K., Martin, C. Leukefeld, C., and Clayton, R.R. Project DARE: No Effects at 10-year Follow-Up. Journal of Consulting & Clinical Psychology, 67, pp. 590-593, 1999.

Early Deviance in the Children of Narcotic Addicts

This descriptive study examined the self-reported behaviors of 285 male and female adolescent children (aged 12-17 yr) of narcotic addicts participating in methadone maintenance programs. These children responded to an 2.5-hour interview questionnaire focusing on current and past activities, including criminal activities prior to age 12. Findings revealed that early deviance, assessed by measures of both severity and variety, was related to current adolescent drug and alcohol use, association with deviant peers, a negative view of home atmosphere, and psychological symptomatology. These results are contrasted with the retrospective reports of adolescent behavior obtained from adult male narcotic addicts in a prior study of vulnerability to addiction. The comparability of study results is discussed in the context of developmental risk factors, prevention and treatment strategies, and other considerations specifically related to the development of children of narcotic addicts. Nurco, D.N., Blatchley, R.J., Hanlon, T.E., and O'Grady, K.E. Early Deviance and Related Risk Factors in the Children of Narcotic Addicts. American Journal of Drug & Alcohol Abuse, 25, 25-45, 1999.

Correlates of Moderate Alcohol Use Versus Problem Alcohol Use

To evaluate the assumption that moderate alcohol use and problem alcohol use represent variations along the same continuum, researchers used a longitudinally ascertained community sample of 15-17-year-old children of alcoholics (COAs) and a demographically matched comparison group (non-COAs) and identified the correlates of adolescent alcohol use and those of problem use. A typology of adolescent alcohol use was created, and alcohol use groups were compared on variables chosen from nine psychosocial domains (parent alcohol use, family functioning, maternal parenting, paternal parenting, stress and emotional distress, peer influences, alcohol expectances, adolescent temperament/personality, and adolescent externalizing symptoms. The correlates of problem alcohol use were different from those of moderate use. Problem use was associated with fundamental family disruptions and poor psychological functioning. In contrast, the determinants of moderate alcohol use reflected unconventionality and socialization specific to alcohol. Few psychosocial variables distinguished abstainers from light drinkers. The findings are consistent with the idea that moderate drinking is associated with a sociocultural context that supports alcohol use while problem alcohol use is associated with psychosocial impairment. This implies that intervention researchers should articulate their outcome of interest and design interventions accordingly; prevention of alcohol problems, for example, might focus on reducing family disruptions and enhancing coping skills, whereas prevention of moderate adolescent drinking might focus on increasing negative expectances about alcohol use and encouraging affiliations with peers who do not use alcohol. Colder, C.R. and Chassin, L. The Psychosocial Characteristics of Alcohol Users Versus Problem Users: Data from a Study of Adolescents at Risk. Development and Psychopathology, 11(2), pp. 321-348, 1999.

Boys' Externalizing Behavior Predicted by Individual Traits and Family Context

Evidence suggests the development of substance abuse is related to prior externalizing behaviors which, in turn, may be related to the temperament traits of parent and child and the quality of the parent-child relationship. These factors may play a mediational role in intergenerational transmission of substance abuse. In research using the CEDAR sample, investigators examined individual traits in a family context to identify processes that account for the relationship between fathers' SUD + status and sons' externalizing behaviors. Results obtained from SUD + (n = 89) and SUD - (n = 139) families show that individual traits, family contextual variables and deviant peer affiliations accounted for 58% of the variance on sons' externalizing behavior scale (EBS) scores. Fathers' abusive propensities toward their sons mediated the relationship between fathers' SUD + status and sons' EBS scores 2 years later. Also, high risk cluster (HRC) and low risk cluster (LRC) memberships were derived from cluster analyses of the continuous risk factor scores that predicted sons' EBS scores. Preliminary relative risk ratios show that sons classified into the HRC at age 10-12 were at greater risk for DSM-III-R conduct disorder and SUD outcomes at age 16 than sons assigned to the LRC, SUD + or SUD - groups. The results support the notion of an ontogenetic pathway to externalizing behavior problems that may be prodromal to CD and SUD outcomes and suggest the need for family-based prevention programs to that take account of family members' temperament traits and abusive propensities of parents toward their offspring in order to reduce the risk of CD and SUD outcomes. Blackson, T.C., Butler, T., Belsky, J., Ammerman, R.T., Shaw, D.S., and Tarter, R.E. Individual Traits and Family Contexts Predict Sons' Externalizing Behavior and Preliminary Relative Risk Ratios for Conduct Disorder and Substance Use Disorder Outcomes. Drug and Alcohol Dependence, 56(2), pp. 115-131, 1999.

Delaying Onset and Progression of Adolescent Substance Abuse

This study examined the effects of the Iowa Strengthening Families Program (ISFP) and the Preparing for the Drug Free Years Program (PDFY) on young adolescent transitions from nonuse of substances to initiation and progression of substance use. Analyses incorporated three waves of data collected over a 2_-year period from 329 rural young adolescents. Outcomes were analyzed by using log linear models that incorporated substance use status frequencies derived from latent transition analyses. Effects on delayed substance use initiation were shown for both the ISFP and PDFY at a two-year follow-up. Also at this follow-up, the PDFY showed effects on delayed progression of use among those previously reporting initiation. Spoth, R., Reyes, M. L., Redmond, C., and Shin, C. Assessing a Public Health Approach to Delay Onset and Progression of Adolescent Substance Use: Latent Transition and Log Linear Analyses of Longitudinal Family Preventive Intervention Outcomes. Journal of Consulting and Clinical Psychology, 67, pp. 619-630, 1999.

Assessing the Benefits of Attending a Parenting Skills Program

Using a theoretical model to ground this investigation, hypotheses about factors that moderate the benefits of attending the Preparing for the Drug Free Years (PDFY) program were tested. PDFY is a skills-training program designed to teach parents and children skills that reduce a child's risk for drug and alcohol use. It was hypothesized that high levels of family stress (i.e., marital difficulties or financial concerns) reduce the benefits of program attendance, and that strong pre-program skills (i.e., parental communication, parental negativity, or parent-child relationship quality) increase the benefits of program attendance. These hypotheses were tested on a sample of families that each included a sixth or seventh grade child. The results for fathers (N = 144) supported the study hypotheses, while mothers (N = 150) who benefited most from the program showed the weakest pre-program communication skills and reported the greatest marital difficulties. Rueter, M.A., Conger, R.D., and Mikler, S. Assessing the Benefits of Attending a Parenting Skills Program: A Theoretical Approach to Predicting Direct and Moderating Effects. Family Relations, 48, pp. 67-77, 1999.

School-based Support Groups for Adolescents with Addicted Parents

A qualitative pilot study that evaluated a school-based support group for adolescents with addicted parents identified mediator variables that are hypothesized to be important for child outcomes. These include knowledge of the impact of addiction on the family, improved relationships with family and friends, enhanced coping strategies, improved resiliency to chaotic environments and improved scholastic performance. In the next phase of this study a profile of adolescents interested in the support group will be developed and the effectiveness of the support groups will also be assessed. Preliminary analyses with a limited sample have indicated that students not interested in participating in the group are more likely to be male, Hispanic, and have a lower grade point average. Murphy-Parker, D. and Gance-Cleveland, B. Examining the Benefits of a School-Based Support Group for Adolescents who have an Addicted Parent. Substance Misuse Bulletin, 12, pp. 7-8, 1999.